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1.
Res Social Adm Pharm ; 17(1): 1876-1881, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32482587

RESUMO

BACKGROUND: COVID-19 is a worldwide public health concern. Disruptions in the drug market are expected and shortages might worsen. Community pharmacies can contribute to early identification and report of medicines' supply and demand issues. OBJECTIVE: The aim of this study is to characterize the impact of the COVID-19 outbreak on outpatient medicines' sales and shortages. METHODS: A retrospective, time-trend analysis of medicine sales, shortages and laboratory-confirmed COVID-19 cases was performed from February 1st to April 30th, 2020, and its homologous period (regarding sales only). A detailed analysis of 6 pharmaceutical substances was performed. All data were subjected to rescaling using the min-max normalization method, in order to become comparable. Data analysis was performed using Microsoft® Excel. RESULTS: The pandemic resulted in an increase in medicines' demand and reported shortages during the early stage of the outbreak. The maximum proportion of medicine sales was registered on March 13th, 2020, 4 days after the WHO declared COVID-19 a pandemic. By the end of March, sales have already dropped to proportions similar to those of 2019. The maximum proportion of drug shortages was reached about one week after the sales peak and by the end of the study period were below those recorded in the pre-COVID-19 period. The analyzed drugs were paracetamol, ascorbic acid, dapagliflozin plus metformin, rosuvastatin plus ezetimibe, formoterol, and hydroxychloroquine, as these pharmaceutical substances registered the highest growth rate in sales and shortages when compared to the same period in the previous year. Hydroxychloroquine showed the most different pattern trends on sales and shortages of these medicines. CONCLUSIONS: Pharmacies can provide timely and real-world data regarding sales and shortages. The adopted measures to guarantee the continuous supply of the medicine market seem to have worked. The long-term impacts of this pandemic are unknown and should continue to be closely monitored.


Assuntos
Comércio/tendências , Serviços Comunitários de Farmácia/estatística & dados numéricos , Preparações Farmacêuticas/provisão & distribução , Serviços Comunitários de Farmácia/economia , Surtos de Doenças , Humanos , Preparações Farmacêuticas/economia , Estudos Retrospectivos , Fatores de Tempo
2.
Lancet Infect Dis ; 21(1): 107-115, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32717205

RESUMO

BACKGROUND: The WHO Access, Watch, and Reserve (AWaRe) antibiotic classification framework aims to balance appropriate access to antibiotics and stewardship. We aimed to identify how patterns of antibiotic consumption in each of the AWaRe categories changed across countries over 15 years. METHODS: Antibiotic consumption was classified into Access, Watch, and Reserve categories for 76 countries between 2000, and 2015, using quarterly national sample survey data obtained from IQVIA. We measured the proportion of antibiotic use in each category, and calculated the ratio of Access antibiotics to Watch antibiotics (access-to-watch index), for each country. FINDINGS: Between 2000, and 2015, global per-capita consumption of Watch antibiotics increased by 90·9% (from 3·3 to 6·3 defined daily doses per 1000 inhabitants per day [DIDs]) compared with an increase of 26·2% (from 8·4 to 10·6 DIDs) in Access antibiotics. The increase in Watch antibiotic consumption was greater in low-income and middle-income countries (LMICs; 165·0%; from 2·0 to 5·3 DIDs) than in high-income countries (HICs; 27·9%; from 6·1 to 7·8 DIDs). The access-to-watch index decreased by 38·5% over the study period globally (from 2·6 to 1·6); 46·7% decrease in LMICs (from 3·0 to 1·6) and 16·7% decrease in HICs (from 1·8 to 1·5), and 37 (90%) of 41 LMICs had a decrease in their relative access-to-watch consumption. The proportion of countries in which Access antibiotics represented at least 60% of their total antibiotic consumption (the WHO national-level target) decreased from 50 (76%) of 66 countries in 2000, to 42 (55%) of 76 countries in 2015. INTERPRETATION: Rapid increases in Watch antibiotic consumption, particularly in LMICs, reflect challenges in antibiotic stewardship. Without policy changes, the WHO national-level target of at least 60% of total antibiotic consumption being in the Access category by 2023, will be difficult to achieve. The AWaRe framework is an important measure of the effort to combat antimicrobial resistance and to ensure equal access to effective antibiotics between countries. FUNDING: US Centers for Disease Control and Prevention.


Assuntos
Antibacterianos/economia , Comércio/economia , Comércio/tendências , Países em Desenvolvimento/estatística & dados numéricos , Uso de Medicamentos/economia , Uso de Medicamentos/tendências , Preparações Farmacêuticas/economia , Gestão de Antimicrobianos , Comércio/estatística & dados numéricos , Uso de Medicamentos/estatística & dados numéricos , Previsões , Humanos , Organização Mundial da Saúde
3.
PLoS One ; 15(10): e0239610, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33048952

RESUMO

Clinical Practice Guidelines (CPGs) play significant roles in most medical fields. However, little is known about the extent of financial Conflicts of Interest (FCOIs) related to pharmaceutical companies (Pharma) selling dermatology prescription products and dermatology CPG authors in Japan. The aims of this study were to elucidate the characteristics and distribution of payments from Pharma to dermatology CPG authors in Japan, and to evaluate the extent of transparency and accuracy in their FCOI disclosures. We analyzed the records of 296 authors from 32 dermatology CPGs published by the Japanese Dermatological Association from the beginning of 2015 to the end of 2018. Using the payment data reported by 79 Pharma between 2016-2017 in Japan, we investigated the characteristics of the CPG authors and the payments from the Pharma to them. Furthermore, we evaluated the transparency and accuracy of the FCOI disclosures of the individual CPG authors. Of the 296 CPGs authors, 269 authors (90.6%) received at least one payment from the Pharma. The total monetary value of payments for the 2-year period was $7,128,762. The median and mean monetary value of payments from the Pharma reporting were $10,281 (interquartile range $2,796 -$34,962) and $26,600 (standard deviation $40,950) for the two years combined. Of the 26 CPG authors who disclosed FCOIs due to the monies received from Pharma, only the atopic dermatitis CPG authors and the acne vulgaris CPG authors published their potential FCOIs. In Japan, most dermatology CPG authors received financial payments from Pharma. The transparency of the CPGs, as reported by the CPG authors, was inadequate, and a more rigorous framework of reporting and monitoring FCOI disclosure is required to improve the accuracy and transparency with relation to possible Conflicts of Interest.


Assuntos
Conflito de Interesses/economia , Dermatologia/economia , Revelação , Indústria Farmacêutica/economia , Guias de Prática Clínica como Assunto , Autoria , Dermatologia/ética , Revelação/ética , Indústria Farmacêutica/ética , Feminino , Apoio Financeiro/ética , Humanos , Japão , Masculino , Preparações Farmacêuticas/economia , Sociedades Médicas/economia , Sociedades Médicas/ética
4.
PLoS One ; 15(10): e0241400, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33125413

RESUMO

In view of the difficulty, high cost and complex technology of pharmaceutical logistics green transformation, based on the idea of green supply chain, three different government subsidy strategies for green logistics were proposed. Firstly, by constructing a Stackelberg game model with pharmaceutical logistics provider as the leader and manufacturer as the followers, the behavior selection and optimal decisions of the participants under the anarchic subsidy strategy, the single subsidy strategy of the pharmaceutical logistics provider, the single subsidy strategy of the pharmaceutical manufacturer and the coordinated subsidy strategy are analyzed respectively. Furthermore, the effects of different subsidy strategies on the green investment and strategy selection of logistics provider and manufacturer are compared. Finally, according to the research results, the paper provides reference and suggestions for the formulation of government subsidy strategy. The results show that the three subsidy strategies have different degrees of incentive effect on the green transformation of pharmaceutical logistics, and the single logistics provider subsidy strategy is the best.


Assuntos
Conservação dos Recursos Naturais , Indústria Farmacêutica , Algoritmos , Simulação por Computador , Conservação dos Recursos Naturais/economia , Tomada de Decisões , Indústria Farmacêutica/economia , Financiamento Governamental , Química Verde/economia , Humanos , Preparações Farmacêuticas/economia , Pesquisa
6.
Int J Equity Health ; 19(1): 133, 2020 08 06.
Artigo em Inglês | MEDLINE | ID: mdl-32762691

RESUMO

BACKGROUND: China carried out a comprehensive drug price reform (CDPR) in 2017 to control the growing expense of drug effectively and reduce the financial burden of inpatients. However, early studies in pilot regions found the heterogeneity in the effectiveness of CDPR from different regions and other negative effects. This study aimed to evaluate the effects of the reform on medical expenses, medical service utilisation and government financial reimbursement for inpatients in economically weaker regions. METHODS: Shihezi was selected as the sample city, and 238,620 inpatients, who were covered by basic medical insurance (BMI) and had complete information from September 2016 to August 2018 in public hospitals, were extracted by cluster sampling. An interrupted series design was used to compare the changing trends in medical expenses, medical service utilisation and reimbursement of BMI for inpatients before and after the reform. RESULTS: Compared with the baseline trends before the CDPR, those after the CDPR were observed with decreased per capita hospitalisation expenses (HE) by ¥301.9 per month (p < 0.001), decreased drug expense (DE) ratio at a rate of 0.32% per month (p < 0.05) and increased ratio of diagnosis and treatment expenses (DTE) at a rate of 0.25% per month (p < 0.01). The number of inpatients in secondary and tertiary hospitals declined by 458 (p < 0.001) and 257 (p < 0.05) per month, respectively. The BMI reimbursement in tertiary hospitals decreased by ¥254.7 per month (p < 0.001). CONCLUSION: The CDPR controlled the increase in medical expenses effectively and adjusted its structure reasonably. However, it also reduced the medical service utilisation of inpatients in secondary and tertiary hospitals and financial reimbursement for inpatients in tertiary hospitals.


Assuntos
Comércio , Custos de Cuidados de Saúde , Reforma dos Serviços de Saúde/economia , Gastos em Saúde , Hospitalização/economia , Hospitais Públicos/economia , Preparações Farmacêuticas/economia , Idoso , China , Cidades , Indústria Farmacêutica/economia , Feminino , Financiamento Governamental , Humanos , Pacientes Internados , Seguro Saúde , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Características de Residência , Fatores Socioeconômicos , Centros de Atenção Terciária/economia
7.
Daru ; 28(2): 799-805, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32617864

RESUMO

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) was characterized as a global pandemic by the WHO on March 11th, 2020. This pandemic had major effects on the health market, the pharmaceutical sector, and was associated with considerable impacts; which may appear in short and long-term time-horizon and need identification and appropriate planning to reduce their socio-economic burden. OBJECTIVES: Current short communication study assessed pharmaceutical market crisis during the COVID-19 era; discussing short- and long-term impacts of the pandemic on the pharmaceutical sector. RESULTS: Short-term impacts of COVID-19 pandemic includes demand changes, regulation revisions, research and development process changes and the shift towards tele-communication and tele-medicine. In addition, industry growth slow-down, approval delays, moving towards self-sufficiency in pharm-production supply chain and trend changes in consumption of health-market products along with ethical dilemma could be anticipated as long-term impacts of COVID-19 pandemic on pharmaceutical sector in both global and local levels. CONCLUSION: The pandemic of COVID-19 poses considerable crisis on the health markets, including the pharmaceutical sector; and identification of these effects, may guide policy-makers towards more evidence-informed planning to overcome accompanying challenges. Graphical abstract .


Assuntos
/economia , Indústria Farmacêutica/economia , Preparações Farmacêuticas/economia , Pesquisa/economia , Indústria Farmacêutica/tendências , Humanos , Preparações Farmacêuticas/provisão & distribução , Formulação de Políticas , Pesquisa/tendências , Telemedicina/tendências , Fatores de Tempo
11.
PLoS One ; 15(6): e0235021, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32579571

RESUMO

BACKGROUND: Many patient organisations collaborate with drug companies, resulting in concerns about commercial agendas influencing patient advocacy. We contribute to an international body of knowledge on patient organisation-industry relations by considering payments reported in the industry's centralised 'collaboration database' in Sweden. We also investigate possible commercial motives behind the funding by assessing its association with drug commercialisation. METHODS: Our primary data source were 1,337 payment reports from 2014-2018. After extraction and coding, we analysed the data descriptively, calculating the number, value and distribution of payments for various units of analysis, e.g. individual companies, diseases and payment goals. The association between drug commercialisation and patient organisation funding was assessed by, first, the concordance between leading companies marketing drugs in specific diseases and their funding of corresponding patient organisations and, second, the correlation between new drugs in broader condition areas and payments to corresponding patient organisations. RESULTS: 46 companies reported paying €6,449.224 (median €2,411; IQR €1,024-4,569) to 77 patient organisations, but ten companies provided 67% of the funding. Small payments dominated, many of which covered costs of events organised by patient organisations. An association existed between drug commercialisation and industry funding. Companies supported patient organisations in diseases linked to their drug portfolios, with the top 3 condition areas in terms of funding-cancer; endocrine, nutritional and metabolic disorders; and infectious and parasitic disorders-accounting for 63% of new drugs and 56% of the funding. CONCLUSION: This study reveals close and widespread ties between patient organisations and drug companies. A relatively few number of companies dominated the funding landscape by supporting patient organisations in disease areas linked to their drug portfolios. This commercially motivated funding may contribute to inequalities in resource and influence between patient organisations. The association between drug commercialisation and industry funding is also worrying because of the therapeutic uncertainty of many new drugs. Our analysis benefited from the existence of a centralised database of payments-which should be adopted by other countries too-but databases should be downloadable in an analysable format to permit efficient and independent analysis.


Assuntos
Indústria Farmacêutica/economia , Apoio Financeiro , Defesa do Paciente/economia , Preparações Farmacêuticas/economia , Conflito de Interesses , Estudos Transversais , Custos de Medicamentos , Humanos , Marketing/economia , Organizações/economia , Organizações/ética , Defesa do Paciente/ética , Suécia
13.
Rev Bras Epidemiol ; 23: e200042, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32428191

RESUMO

INTRODUCTION: The acquisition of medicines accounts for a significant proportion of private health expenditures. The objective of this study was to analyse the private spending with the purchase of medicines and the commitment of the family income, by the elderly. METHODS: Population survey conducted in Praia Grande, São Paulo, Brazil. The monthly expenditure and the per capita family income commitment with the purchase of medicines were calculated from the information obtained in the interviews. The variables were described in absolute and relative frequencies and the hypothesis test was Pearson's χ2, Student's t and Anova, with a significance level of 5%. RESULTS: The prevalence of drug use was 61.2%. The average monthly expenditure per capita was R$ 34.59, with significantly higher income impairment for individuals with higher levels of education, without chronic diseases and health plan beneficiaries. CONCLUSION: The prevalence of drug use was low. The cost generated by the purchase of medicines is one of the ways in which inequality can manifest in society. The expansion of free drug provision would be necessary to expand access and avoid spending, especially those who have private health plans but cannot afford drug treatment.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Renda/estatística & dados numéricos , Preparações Farmacêuticas/economia , Idoso , Idoso de 80 Anos ou mais , Brasil , Cidades , Custos de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/estatística & dados numéricos , Preparações Farmacêuticas/provisão & distribução , Fatores Socioeconômicos , Estatísticas não Paramétricas
15.
Zhonghua Er Ke Za Zhi ; 58(4): 301-307, 2020 Apr 02.
Artigo em Chinês | MEDLINE | ID: mdl-32234137

RESUMO

Objective: To investigate the availability, prices and affordability of essential medicines in pediatric population across China, in the hope of improving rational use of medicines. Methods: A multicenter cross-sectional survey of medicine prices, availability and affordability was conducted in 17 provinces, municipalities and autonomous region across east, south-central part, west and north of China. Data on 42 medicines used in pediatric population, both original and generic, were collected in 55 public hospitals from May 26 to June 2, 2017. Availability was expressed as the percentage of hospitals with stock of the target medicine on the day of data collection,and median price ratio (MPR) was the ratio of price upon investigation to international reference. Based on national minimum daily wage, affordability represents the number of working days needed to earn the expense which covers a standard course using the target medicine. Statistical software SPSS 13.0 was applied for descriptive analysis of availability, MPR and affordability. Results: Mean Availability of original and generic medicine was 33% and 32%, with median MPR being 5.43 and 1.55. Among the 19 medicines with price information for both original and generic product, the median MPR was 7.73 and 2.04 respectively. Regarding the five medicines used to treat four common pediatric diseases (pneumonia,peptic ulcer, congenital hypothyroidism, refractory nephrotic syndrome), the affordability was 0.63 (0.16-6.17) d for generic medicine, and 1.03 (0.16-11.53) d for its original counterpart. Conclusions: The availability to both original and generic products of the 42 medicines used in pediatric population was low in China. The prices of generic medicines seem to be lower and affordability higher than those of original medicines. There is an urgent need to improve the availability and affordability of pediatric medicines.


Assuntos
Preparações Farmacêuticas/economia , Preparações Farmacêuticas/provisão & distribução , Criança , China , Estudos Transversais , Custos de Medicamentos , Medicamentos Genéricos/economia , Medicamentos Genéricos/provisão & distribução , Humanos , Pediatria
16.
Guatemala; MSPAS, Coordinación de Hospitales; 27 mar 2020. 15 p. graf.
Não convencional em Espanhol | LILACS, LIGCSA | ID: biblio-1096347

RESUMO

Este documento da orientación provisional procura fortalecer la respuesta de los servicios hospitalarios ante la posibilidad de tener casos en el país de COVID-19, especialmente en la parte de prevención de la transmisión a del fortalecimiento de las precauciones estándar para la prevención y control de infecciones, con énfasis en el lavado de manos y el uso de equipo protección personal por parte del personal de salud. Además, provee orientaciones para organizar los servicios hospitalarios para adecuar áreas de aislamiento, cuidados intermedios y áreas de triage. El documento también orienta para la proyección de costos de insumos: Material medico quirúrgico, medicamentos, recursos humanos, entre otros como preparación para la respuesta (AU).


Assuntos
Humanos , Organização e Administração/normas , Pneumonia Viral/diagnóstico , Controle de Infecções , Infecções por Coronavirus/diagnóstico , Betacoronavirus , Assistência ao Paciente/métodos , Cadáver , Preparações Farmacêuticas/economia , Organizações , Pessoal de Saúde , Contenção de Riscos Biológicos/normas , Equipamentos e Provisões , Sistema de Vigilância Sanitária , Programa de Controle de Infecção Hospitalar , Guatemala , Resíduos de Serviços de Saúde/prevenção & controle
17.
Glob Health Action ; 13(sup1): 1695241, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32194014

RESUMO

Background: Pharmaceutical corruption is a serious challenge in global health. Digital technologies that can detect and prevent fraud and corruption are particularly important to address barriers to access to medicines, such as medicines availability and affordability, stockouts, shortages, diversion, and infiltration of substandard and falsified medicines.Objectives: To better understand how digital technologies are used to combat corruption, increase transparency, and detect fraud in pharmaceutical procurement systems to improve population health outcomes.Methods: We conducted a multidisciplinary review of the health/medicine, engineering, and computer science literature. Our search queries included keywords associated with medicines procurement and digital technology in combination with terms associated with transparency and anti-corruption initiatives. Our definition of 'digital technology' focused on Internet-based communications, including online portals and management systems, supply chain tools, and electronic databases.Results: We extracted 37 articles for in-depth review based on our inclusion criteria focused on the utilization of digital technology to improve medicines procurement. The vast majority of articles focused on electronic data transfer and/or e-procurement systems with fewer articles discussing emerging technologies such as machine learning and blockchain distributed ledger solutions. In the context of e-procurement, slow adoption, justifying cost-savings, and need for technical standards setting were identified as key challenges for current and future utilization.Conclusions: Though there is a significant promise for digital technologies, particularly e-procurement, overall adoption of solutions that can enhance transparency, accountability and concomitantly combat corruption, is still underdeveloped. Future efforts should focus on tying cost-saving measurements with anti-corruption indicators, prioritizing centralization of e-procurement systems, establishing regulatory harmonization with standards setting, and incorporating additional anti-corruption technologies into procurement processes for improving access to medicines and to reach the overall goal of Universal Health Coverage.


Assuntos
Fraude/prevenção & controle , Saúde Global/ética , Invenções , Preparações Farmacêuticas/economia , Preparações Farmacêuticas/provisão & distribução , Cobertura Universal do Seguro de Saúde/ética , Cobertura Universal do Seguro de Saúde/organização & administração , Humanos , Estudos Interdisciplinares , Responsabilidade Social
18.
Glob Health Action ; 13(sup1): 1694745, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32194011

RESUMO

Background: The goal of the public procurement of pharmaceuticals is to purchase sufficient quantities of high-quality pharmaceuticals at cost-effective prices for a given population. This goal can be undercut if corruption infiltrates the procurement process. Good procurement practices can help mitigate the risks of corruption and support equitable access to affordable and high-quality medicines.Objectives: This paper aims to 1) examine manifestations of corruption in the pharmaceutical procurement process and key factors behind them, and 2) identify how to design and implement effective anti-corruption, transparency and accountability mechanisms within this process.Methods: This paper was informed by a narrative literature review from 1996 to the present. The search focused on publications that addressed the issue of pharmaceutical procurement and governance and corruption issues. Our search included peer-reviewed literature, books, grey literature such as working papers, reports published by international organizations and donor agencies, and some media articles. Some documents used in this paper were already known to the authors.Results: Procurement is highly vulnerable to corruption particularly in the health sector. What is more, corruption in the procurement process does not appear to be limited to any one level of government or type of health system. The better integration of accountability, transparency and anti-corruption mechanisms in the procurement process is needed to reduce the risk of corruption.Conclusions: Lessons learned suggest that anti-corruption, transparency and accountability mechanisms in the pharmaceutical procurement process, such as open contracting and integrity pacts are helpful towards reducing the risk of corruption.


Assuntos
Fraude/ética , Fraude/prevenção & controle , Programas Governamentais/ética , Programas Governamentais/estatística & dados numéricos , Preparações Farmacêuticas/economia , Preparações Farmacêuticas/provisão & distribução , Responsabilidade Social , Fraude/estatística & dados numéricos , Humanos
19.
BMC Health Serv Res ; 20(1): 80, 2020 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-32013963

RESUMO

BACKGROUND: Recently, the Executive Branch and Judiciary in Brazil increased spending due to larger numbers of lawsuits that forced the State to provide health goods and services. This phenomenon, known as health judicialization, has created challenges and required the Executive Branch and Judiciary to create institutional strategies such as technical chambers and departments to reduce the social, economic and political distortions caused by this phenomenon. This study aims to evaluate the effects of two institutional strategies deployed by a Brazilian municipality in order to cope with the economic, social and political distortions caused by the phenomenon of health judicialization regarding access to medicines. METHODS: A longitudinal study was carried out in a capital in the Central-West Region of Brazil. A sample of 511 lawsuits was analyzed. The variables were placed into three groups: the sociodemographic characteristics and the plaintiffs' disease, the characteristics of the claimed medical products and the institutional strategies. To analyze the effect of the interventions on the total cost of the medicines in the lawsuits, bivariate and multivariate linear regressions with variance were performed. For the categorical outcomes, Poisson regressions were performed with robust variance, using a significance level of 5%. RESULTS: A reduction in the costs of medicines in the lawsuits and of the requests for medicines within the SUS formulary was verified after the deployment of the Department of Assessment of Nonstandardized Medicines (DAMNP) and the Technical Chamber of Health Assessment (CATS); an increase in processed prescriptions from the Brazilian Universal Health System was observed after the deployment of the CATS; and an increase in medicines outside the SUS formulary without a therapeutic alternative was verified after the CATS. CONCLUSION: The institutional strategies deployed were important tools to reduce the high costs of the medicines in the lawsuits. In addition, they represented a step forward for the State, provided a benefit to society and indicated a potential path for the health and justice systems of other countries that also face problems caused by the judicialization of health.


Assuntos
Política de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/legislação & jurisprudência , Preparações Farmacêuticas/economia , Assistência Farmacêutica/legislação & jurisprudência , Brasil , Cidades , Custos e Análise de Custo , Humanos , Estudos Longitudinais
20.
PLoS One ; 15(2): e0224761, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32069295

RESUMO

The United States has experienced prolonged severe shortages of vital medications over the past two decades. The causes underlying the severity and prolongation of these shortages are complex, in part due to the complexity of the underlying supply chain networks, which involve supplier-buyer interactions across multiple entities with competitive and cooperative goals. This leads to interesting challenges in maintaining consistent interactions and trust among the entities. Furthermore, disruptions in supply chains influence trust by inducing over-reactive behaviors across the network, thereby impacting the ability to consistently meet the resulting fluctuating demand. To explore these issues, we model a pharmaceutical supply chain with boundedly rational artificial decision makers capable of reasoning about the motivations and behaviors of others. We use multiagent simulations where each agent represents a key decision maker in a pharmaceutical supply chain. The agents possess a Theory-of-Mind capability to reason about the beliefs, and past and future behaviors of other agents, which allows them to assess other agents' trustworthiness. Further, each agent has beliefs about others' perceptions of its own trustworthiness that, in turn, impact its behavior. Our experiments reveal several counter-intuitive results showing how small, local disruptions can have cascading global consequences that persist over time. For example, a buyer, to protect itself from disruptions, may dynamically shift to ordering from suppliers with a higher perceived trustworthiness, while the supplier may prefer buyers with more stable ordering behavior. This asymmetry can put the trust-sensitive buyer at a disadvantage during shortages. Further, we demonstrate how the timing and scale of disruptions interact with a buyer's sensitivity to trustworthiness. This interaction can engender different behaviors and impact the overall supply chain performance, either prolonging and exacerbating even small local disruptions, or mitigating a disruption's effects. Additionally, we discuss the implications of these results for supply chain operations.


Assuntos
Tomada de Decisões , Preparações Farmacêuticas/provisão & distribução , Confiança/psicologia , Simulação por Computador , Equipamentos e Provisões Hospitalares/tendências , Humanos , Modelos Organizacionais , Preparações Farmacêuticas/economia , Estados Unidos
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